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What are individuals jt ROM affected by?
- genetic makeup
- age of patient
- presence/absence of any disease process=may increase or decrease ROM
- amt and type of physical activity
What is an abnormal condition in which theres a shortening and tightening of a set of muscles, tendons, or ligaments and a stretching of the opposite muscle groups?
What is flaccid?
lack of voluntary motion and muscle tone. decrease in muscle tone
stroke patients initially
What three conditions are part of the upper motor neurons, which affects CNS?
What is sustained involuntary muscle contractions with abnormal and increased muscle tone?
-can work with this a little to loosen it up
What is a clonus?
rapid, alternating contraction and relaxation of muscles with CNS damage typically triggered by a quick stretch. rapid bouncing
-kinda of like a tremor
What is a constant, involuntary resistance to mvmt with hypertonicity?
- -parkinsons patients
- -very stiff
What are the 2 types of rigidity?
lead pipe- struggle, never moves (empire state)
cog wheel- jerks, it will let go just a little
What is a muscle contraction in response to injury?
What is a bony union that forms when a contracture has maintained a joint in stable position for a long period of time?
What is hypotonicity?
decreased muscle tone
What is hypertonicity?
increased muscle tone
stroke (initially after onset)
What is full range?
when a muscle contracts to the limit of its normal capacity from a position of full stretch
What is outer range?
from full stretch to mid-point of full range
What is inner range?
from mid point to full contraction
What is middle range?
any distance betwen the middle of the outer range and the middle of the inner range
In general, what are the methods of controlling progression of a program?
- 1. easiest -> hardest
- 2. isometric -> isotonic -> isokinetic
- 3. large muscle groups ->smaller groups
Specifically, what are 7 ways we can controll the progression of a program?
- 1. change length of rest period
- 2. increase number of sets/bouts
- 3. increase repetitions
- 4. increase weight/intensity
- 5. change speed
- 6. change starting postition
- 7. combine exercises (when a pt is acute, normally only work with one plane..as they progress we combine exercises and planes)
What are some precautions to be aware of with exercise programs?
- protect the ind. from undue strain
- be sure pt is maintaining fair breathing (watch for valsalva maneuver)
- be aware of differences in firm/soft surfaces
- make sure exercise isnt too strenuous, adjust accordingly
What are 2 indications of too much ROM or wrong motion?
- increased pain
- increased inflammation
What are some things position selection is based on?
- presence of pain or discomfort
- ability to assume the position desired
- use a short lever arm vs a long lever arm
- need to stabilize body parts
- use of gravity for assistance or resistance
What is the valsalva maneuver?
exhalation against a closed glottis
- decreased blood flow to heart, cardiac output, arterial BP
- alter heart rate
- increase stress on CV system, intra-abdominal pressure
What are some indications for PROM?
- elderly pts with limited mobility/mentation
- pts on complete bed rest
- paralyzed pts
- when active motion is contraindicated (some cardiacs, postsurgical, actue inflam/pain)
- when active motion produces unwanted muscle tone
What is the goal of PROM?
maintain existing jt and soft tissue mobility to prevention of contractures
What are some limitations for PROM?
- difficult to get conscious pt to relax
- will not: prevent atrophy, increase strength or endurance
- will not assist circulation
What is an indication for AAROM?
weak musculature (whenever a pt can actively contract muscles but needs some assistance to complete or initiate range)
What is the goal of AAROM?
maintain physiologic elasticity an contractility of muscles and gradually increase strength and ROM
When are both PROM and AAROM both contraindicated?
under any circumstance where mvmt of a part would disrupt healing
What are some examples of possible disruptive healing contraindications?
- imm. following ligament, muscle, tendon, or joint tear or surgical repair (some are allowed)
- unhealed fractures
- unstable CV pts (s/p MI, angina)
- pulmonary emboli untreated (like DVT)
- blood clot (DVT)
What are some effects of PROM?
- assist circulation
- decreased jt contracture
- maintains jt and soft tissue integrity
- decreases pain
- enhance synovial movement
- assist in healing
- awareness of mvmt
- maintain elasticity
What are some affects of AROM and AAROM?
- all those of PROM plus:
- increase circulation and prevent thrombus formation
- maintain physiologic elasticity and contractility
- provide sensory feedback from the contracting muscle
- provide a stimulus for bone and jt tissue integrity
- develop coordination and motor skills for functional activities
What are affects of RROM?
everything for PROM/AROM/AAROM
What type of ROM is used to strengthen is pt is weak?
What type or ROM is used to help improve CV with an aerobic program?
if done with mulitple reps and results are monitored
What will AROM not do?
- maintain or improve strength in strong muscles
- will only develop skill or coordination in patterns used
With what type of insufficiency does the muscle shorten and contract to the fullest extent (will go no further)?
With what type of insufficiency are the muscles fully elongated over 2 joints and wont stretch anymore?
What is CPM?
continuous passive motion
- -motion uninterrupted for extended periods of time
- -usually mechanical
- -all passive-no muscle fatigue
Who introduced the concept of CPM?
dr. robert salter
What are some benefits of CPM?
- may reduce adhesions/contracture formation
- decrease pain and edema
- enahnce nutrition to a joint
- increase synovial fluid lubrication
- promote wound healing
- counteracts ill effects of immobilization
- maintain/increase PROM
- restore gliding
- reduce jt stiffness
What are some contraindications of CPM?
- active infection
- tendon quality
- fracture status
- tendon nutrition
- vascular status
- pt makeup
- gadget tolerance
- social/financial support